Baccalaureate Nursing Education in China: Issues and Challenges

Article excerpt

ABSTRACT As the baccalaureate becomes the new standard for nursing practice in China, nursing education is pivotal. The authors review the history and the current situation of nursing education and practice in China and discuss issues concerning baccalaureate graduates and the challenges in Chinese nursing education.

Key Words Nursing Education in China--Baccalaureate Nurse Graduates--Nursing Shortage in China--Nurse Faculty in China

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NURSING EDUCATION HAS BEEN CHANGING AS THE PROFESSION ADVANCES IN CHINA, A NATION WITH A RISING POPULATION OF OLDER ADULTS AND A SEVERE NURSING SHORTAGE (CHAN & WONG, 1999; HU & LIU, 2004). As nurses in China increasingly seek to connect with the international nursing profession, the baccalaureate is becoming the new standard requirement for nurses (Chan & Wong; Sherwood & Liu, 2005). A review of current practice and the history of nursing education will help explain why this degree has become the new professional standard.

Nursing Practice in China The traditional view in China of the nurse as passive and subservient to the will of the physician (Xu, 2006) is illustrated by a common saying: "The doctor's mouth directs the nurse's legs." Nursing's status is changing, however, and as Fang (2007) explains, legislators and researchers have been working together to raise awareness of the importance of nurses' work.

Pang et al. (2004) found that Chinese nurses' views of the profession are based on Chinese medicine and Eastern philosophy. Nurses value nursing as a earing discipline broadly concerned with health promotion, quality of life, and social interaction. More than 300 nurses validated the following definition of nursing at an annual meeting of the China Association for Science and Technology: "Nursing means to understand the dynamic health status of a person, to dialectically verify health concerns, and to devise interventions with the goal of assisting the person to master the appropriate health knowledge and skills for the attainment of optimal well-being" (Pang et al., p. 661).

This definition is an example of the valuable ways Chinese nurses can enrich the global nursing community, by applying holistic nursing care to improve the physical and mental health of patients. Traditional Chinese nurses could only provide patient care based on physicians' orders. With the new definition of nursing, Chinese nurses use their knowledge and skills and the nursing process to deliver care to patients and assume the role of educator.

Nursing in China has traditionally been practiced in a three-tiered hospital system consisting of provincial, county, and township hospitals (Hu & Liu, 2004). Historically, primary care was provided in rural areas by physicians with only a secondary (diploma program) education--the so-called barefoot doctors (Anders & Harrigan, 2002).

Fang (2007) reported on the Chinese government's plan, announced in 1997, to put in place a nationwide community health infrastructure by 2010. Community health is a new area for nursing practice, occurring predominantly in community health service centers, each serving three or four communities, with one nurse per 4,000 residents (Xu, Wang, & Xu, 2003). Services provided at these centers include disease prevention and control, health promotion, health education and counseling, recuperative and rehabilitative services, epidemiology and surveillance, home health care, and family planning. Provision of such services is complicated by the nursing shortage and inadequate infrastructures. Also, many underserved citizens do not understand the value of community health nursing, nor do they hold nurses in high esteem. Therefore, they expect to be treated by physicians rather than nurses at community health service centers (Xu et al., 2003).

Job satisfaction and retention of nurses are prime concerns in China. Hu and Liu (2004) found that salary, promotions, management, and continuing education opportunities, among other factors, affected retention. …